Informed Consent

Treatment To Be Done: I understand and consent to have any treatment done by the dentist after the procedure, the risks & benefits & cost have been fully explained. These treatments include, but are not limited to, x-rays, cleanings, periodontal treatments, fillings, crowns, bridges, all types of extraction, root canals, and/or dentures, local anesthetics & surgical cases.

Drugs & Medications: I understand that antibiotics, analgesics, and other medications can cause allergic reactions like redness and swelling of tissues, pain, itching, vomiting, and/or anaphylactic shock.

Changes in Treatment Plan: I understand that during treatment it may be necessary to change and add procedures because of conditions found while working on the teeth that were not discovered during examination. I give my permission to the dentist to make any/all changes and additions as necessary with my responsibility to pay all the costs agreed.

Radiograph: I understand that an x-ray or radiograph may be necessary as a diagnostic aid, but this does not provide 100% assurance for treatment accuracy as complications may arise.

Removal of Teeth: I understand the alternatives to tooth removal and the associated risks. I understand that removing teeth may not eliminate all infections and that further treatment may be needed. I accept the risks involved including pain, swelling, dry socket, nerve damage, and possible need for specialist referral.

Crowns and Bridges: I understand that preparing a tooth may irritate the nerve and may lead to sensitivity or root canal therapy. I am aware of limitations with color matching and the risks of delay in returning for permanent cementation. I accept responsibility for remakes and final approval before cementation.

Endodontics (Root Canal): I understand root canal treatment is not guaranteed to save a tooth. Complications may occur. I accept the risks including file breakage and the need for referral to a specialist, which may result in additional costs.

Periodontal Disease: I understand the seriousness of periodontal disease and treatment options. I understand that any dental procedure can affect periodontal health.

Fillings: I understand the care required post-filling and the possibility of sensitivity or the need for further treatment such as crowns or root canals.

Dentures: I understand the challenges with dentures, especially immediate ones, and the need for adjustments and permanent relines. I understand the responsibility of returning on time and the associated fees for delays or modifications.

I understand that Dentistry is not an exact science and that no dentist can properly guarantee accurate results all the time.

I hereby authorize any of the doctors/dental auxiliaries to proceed with and perform the dental restorations and treatments as explained to me. I understand that these are subject to modification depending on undiagnosable circumstances that may arise during the course of treatment.

I understand that regardless of any dental insurance coverage I may have, I am responsible for payment of dental fees. I agree to pay any attorney's fees, collection fees, or court costs that may be incurred to satisfy any obligation to this office.

All treatment was properly explained to me, and in case of any untoward circumstances, I will not hold the attending dentist liable as I am undergoing this treatment of my own free will and with full trust and confidence in their care.